Background: The average cost for tuition, fees, and living expenses at 50% of United States medical schools exceeds $275,000. In addition, a career in medicine requires 3-7 years of residency training and sometimes 1-3 years of fellowship training at a fraction of their projected income. Virtually no data exists on the credit profiles of internal medicine borrowers and the reasons for their borrowing. In the first analysis of its kind, we assessed the credit profiles of physician borrowers by FICO score, training or career stage, and reasons for borrowing.

Methods: This cross-sectional study was based on pooled FICO scores from 974 internal medicine trainee and attending borrowers from 2019-2023 sourced from a privately held physician and dentist financial services company in compliance with the Equal Credit Opportunity Act (ECOA). Borrowers applied for loans from October 1, 2019 to May 31, 2023. Descriptive analyses were performed characterizing the median borrower FICO score based on status (trainee vs. attending), years from training, and reasons for loan requests. FICO score excludes age, employment history, gender, location, income, marital status, national origin, and race to protect customers from potentially discriminatory credit decisioning. The FICO score pulls data from the three credit bureaus (Equifax, Experian, and Transunion) weighing the following categories when being calculated: payment history (35%), amounts owed (30%), length of credit history (15%), recent credit applications (10%), and credit mix (10%).

Results: The national median FICO scores were 679 (n=500; IQR=648-721) among trainees and 731 (n=474; IQR=683-778) among attending physicians (p<0.001). There was no statistically significant difference among physician FICO scores by geography. Credit card consolidation was the most common reason for borrowing across both cohorts followed by moving/relocation among trainees and home improvement among attendings.

Conclusion: The median FICO scores of trainees is 11 points lower than the average American of their generation; for attendings, the median FICO score is 4 points higher. This is surprising given the personal character and comparative salary of physicians. Financial stresses reflected in FICO score can contribute to broader physician burnout and further the cycle of stress and shortage.